Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 036127342 | IL |
NPI | 1346278041 |
---|---|
Provider Name | Laurent Brard |
First Address | Springfield, IL 62794-9640 |
Second Address | Springfield, IL 62702-5303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 20/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036127342 | (05) | IL |
H85217 | (02) | RI |